CHAPTER 17

LECTURE EXTENSION

Reducing Falls and Resulting Hip Fractures among Older Women

As noted in the text, fall-related injuries are the leading cause of injury deaths and disabilities in late adulthood. The most serious fall injury is hip fracture; one-half of all older adults hospitalized for hip fracture never regain their former level of functioning. In 1996, a total of 340,000 hospitalizations for hip fracture occurred among persons aged 65 years and older, and 80 percent of these admissions occurred among women. From 1988 to 1996, hip fracture hospitalization rates for women aged 65 years and older increased 23 percent.

Risk factors for falls include increasing age, muscle weakness, functional limitations, environmental hazards, use of psychoactive medications, and a history of falls. Age is also a risk factor for hip fracture. Women 85 years and older are nearly eight times more likely than women aged 65 through 74 years to be hospitalized for hip fracture. White women aged 65 years and older are at higher risk for hip fracture than black women. Other risk factors for hip fracture include lack of physical activity, osteoporosis, low body mass index, and a previous hip fracture.

Because approximately 95 percent of hip fractures result from falls, minimizing fall risk is a practical approach to reducing these serious injuries. Research demonstrates that effective fall prevention strategies require a multifaceted approach, with both behavioral and environmental components. Important elements include education and skill building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards, and medication assessment to minimize side effects (for example, dizziness and grogginess).

Coordination needs to be improved among the diverse federal, state, and local organizations that conduct fall prevention activities. The effectiveness of existing fall prevention programs among specific groups of women (for example, those aged 85 years or older or living with functional limitations) needs careful evaluation. New primary fall prevention approaches are needed (for example, characterizing footwear that promotes stability), as well as secondary prevention strategies (for example, protective hip pads) that can prevent injuries when falls occur. Finally, increased collaboration among national experts from various disciplines is needed, to reach consensus regarding priority research areas and program issues, and to work toward long-term strategies for reducing falls and fall-related injuries among older adults.

Persons 65 years and older constitute the fastest-growing segment of the U.S. population. Without effective intervention strategies, the number of hip fractures will increase as the U.S. population ages. Fall prevention programs have reduced falls and fall-related injuries among high-risk populations using multifaceted approaches that include education, exercise, environmental modifications, and medication review. These programs need to be evaluated among adults aged 65 years and older who are living independently in the community. In addition, secondary prevention strategies are needed to prevent hip fractures when falls occur.

Centers for Disease Control and Prevention (2000). Reducing falls and resulting hip fractures among older women. MMWR Recommendations and Reports, 49, 1-12.

LEARNING ACTIVITY

Discovering Opportunities for Lifelong Learning in Your Community

Ask students to gather information about lifelong learning in your community. Elderhostel programs, college courses designed for older adults, travel groups, book discussions at public libraries, and field trips offered by community centers are a few of the programs available in many communities. Many programs will have brochures, fliers, or course descriptions available which describe the content of the activities. Local newspapers and newsletters published specifically for older adults also are good sources of information about community events. Information from these sources will give students additional insight regarding the diverse interests and learning abilities of older adults.